Incidence and Prognosis of Ventilator-Associated Pneumonia in Critically Ill Patients with COVID-19: A Multicenter Study

• Main Authors: Daniele Roberto Giacobbe, Denise Battaglini, Elisa Martina Enrile, Chiara Dentone, Antonio Vena, Chiara Robba, Lorenzo Ball, Michele Bartoletti, Irene Coloretti, Stefano Di Bella, Antonio Di Biagio, Iole Brunetti, Malgorzata Mikulska, Novella Carannante, Andrea De Maria, Laura Magnasco, Alberto Enrico Maraolo, Michele Mirabella, Giorgia Montrucchio, Nicolò Patroniti, Lucia Taramasso, Giusy Tiseo, Giacomo Fornaro, Fiorentino Fraganza, Luca Monastra, Erik Roman-Pognuz, Giacomo Paluzzano, Giuseppe Fiorentino, Antonio Corcione, Linda Bussini, Renato Pascale, Silvia Corcione, Tommaso Tonetti, Matteo Rinaldi, Marco Falcone, Emanuela Biagioni, Vito Marco Ranieri, Maddalena Giannella, Francesco Giuseppe De Rosa, Massimo Girardis, Francesco Menichetti, Pierluigi Viale, Paolo Pelosi, Matteo Bassetti
• Format: Article
• Language: English
• Published: MDPI AG 2021-02-01
• Series: Journal of Clinical Medicine
• Subjects: VAP; COVID-19; SARS-CoV-2; coronavirus; ventilation
• Online Access: https://www.mdpi.com/2077-0383/10/4/555
• ISSN: 2077-0383

The primary objective of this multicenter, observational, retrospective study was to assess the incidence rate of ventilator-associated pneumonia (VAP) in coronavirus disease 2019 (COVID-19) patients in intensive care units (ICU). The secondary objective was to assess predictors of 30-day case-fatality of VAP. From 15 February to 15 May 2020, 586 COVID-19 patients were admitted to the participating ICU. Of them, 171 developed VAP (29%) and were included in the study. The incidence rate of VAP was of 18 events per 1000 ventilator days (95% confidence intervals [CI] 16–21). Deep respiratory cultures were available and positive in 77/171 patients (45%). The most frequent organisms were <i>Pseudomonas aeruginosa</i> (27/77, 35%) and <i>Staphylococcus aureus</i> (18/77, 23%). The 30-day case-fatality of VAP was 46% (78/171). In multivariable analysis, septic shock at VAP onset (odds ratio [OR] 3.30, 95% CI 1.43–7.61, <i>p</i> = 0.005) and acute respiratory distress syndrome at VAP onset (OR 13.21, 95% CI 3.05–57.26, <i>p</i> < 0.001) were associated with fatality. In conclusion, VAP is frequent in critically ill COVID-19 patients. The related high fatality is likely the sum of the unfavorable prognostic impacts of the underlying viral and the superimposed bacterial diseases.